Hello everyone, this is my first post as a dialysis nurse and we need help. I am a RN at a small rural chronic dialysis center, we have 12 chairs and we have 3 shifts 6 days a week, all shifts are pretty much full except for Tues, Thurs, and Sat and the third shift is pretty small but I rarely work those days, we have a full time charge nurse 4 days a week and I fill in the one day that she is not there and she only works 8 til 4:30 so I take care of everthing like orders and problems after she leaves but I still have my patients to take care but anyway, the problem that we are having is shift change, sometimes we have 6 patients coming off at the same time and then we have 6 who need to be put on, so its like a crazy house for atleast 2 hours during each change over, we usally have one RN and 2 Lpns and 2 techs sometimes 3 and then we have our charge nurse and our unit manager but neither take patients but will sometimes help during change over but not usually and after 4:30 when the day people go home we might have 2 nurses and 1 to 2 techs but we will still have 11 pts on the machines, we are all experiecing major burnout and one of our best techs put in her two weeks notice and several of the nurses are looking elsewhere including myself, I love dialysis but I think Im burned out and not sure what to do, the techs come in at 5:30 and get the machines ready, the nurses come in at 6:00 and we start putting pts on at 6:30 and we are getting out around 7:30 to 8:00, we are having a staff meeting tomorrow night to try to figure a better way of scheduling pts and maybe staggering them so that so many are not coming off at the same time, everyone is complaining about being so shortstaffed and worked to death, but Im not sure that we are understaffed, we do have some lay time but not very much, the doc has given us so many protocols to follow according to lab and etc.. that we are writing all of the orders, he doesnt like to be bothered because he is to busy and our lpns do not like to call the doc and its the RNs responsiblity to call on all of the patients and our techs do not put on or take off, we have a couple who can do that but only when they have to like short a nurse for the day, sorry, I know that Im rambling but Im very frustrated and I just was wondering if we really have it made at our clinic and are just spoiled or if we really have a reason to be complaining and everyone has been and so were having this meeting, any advice or comments are appreciated, oh I think that I forgot to meantion that Ive been doing this for a little over a year and I really love dialysis overall and want to stay in it. :o
HI Thanks for the welcome and I am sure glad to hear ( read) your voice!! Yes, that info does help:) Could you give me an idea of the shift times in general? I should have asked but again was to excited!!
Again, that depends on your particular unit.. they vary, but you can figure on it being quite early. Our first patients go on at 0500, meaning that we are htere by 0415-0430 to get the machines ready and tested, bicarb and acid out, etc.... Running two shifts, we are usually done then and leaving by approx. three pm.. if all goes well.
Some clinics start a bit later. like 0600... but that's the latest I know of any starting.. still means you'd need to be there a good half hour earlier.
You might want to go back and chat with them and get all the details... or give them a call and make notes.
Thank you so much. Any info or advice is greatly appreciated. Yes I am going to speak with them again. I have worked at the same place since I received my RN in 1995 and am only gathering the courage to move on. I really think this might be the right area for me but I guess I'll see hey!?
Our facility is large. 24 chairs broken up into 3 sections of 8 chairs. We have 4 shifts on MWF and 3 shifts on TTS. First folks get there by 4:30 and we try to open the doors to the patients by 5:30. There are usually 8 of us putting on patients non-stop from 5:30-7am, then it slows down a bit until turnover, which usually starts around 9:30 or so with the first pts getting off. Then it's busy for another hour or two while we are taking pts off, putting the next shift's pts on, and tearing down/setting up the machines.
As for the bicarb, one person is responsible for mixing and transferring bicarb throughout the morning, another in the afternoon. (We switch off at 2pm) Usually we're scheduled for bicarb duty every 2 weeks or so.
I hope you'll enjoy working in dialysis! Good luck!
I must be blessed. I work Mon-Sat. Shifts are 0730-1600 or 1300-2130.
Usually 11, sometimes 12 chairs. At times we have to squeeze a few in between outpatient times (this is an acute facility).
All of our baths are ready to go unless we need to increase someone's K, then we have to add some.
EVERYTHING is disposable. We do not reuse anything. The most patients that have been dialysed in my unit in one day is about 35 i think. Thankfully I was not on that day!
GOdd Morning to all!!! Thank you for your info and wish for luck. I am very excited about this change as I have been in geriatric nursing since I became an RN and am definitely ready to move on. I'm curious, does anyone work for Fresenius Medical? This is the company I was hired for
Boy do these words sound familiar. Been there myself a few too many times. The key to a good turnaround is the patient schedule and who is in charge of it. As long as nurses let the pct's run the schedule we are going to be run off of our feet. One of the tech's challenges is to get the shift on faster. This is not always a good thing. When you set up your schedule you need to look at times off. It is best to have at the minimum 15minutes between patients and at least 30 but preferably 45 minutes to turn the machine around. (15minutes for the patient and 30 minutes for the machine). When you do this there is less stress and everyone benefits. Try this to see if you can get buy in. If there isn't buy in by the team it won't work. The nurses have to take charge of the schedule and no one can call a patient in without the nurses approval. :balloons:
I'm an RN in a large clininc (50 chairs divided into 2 nursing stations). Usually get an assignment of 3 or 4 patients. The "on-times" are supposedly staggered, but it makes no difference--0the "on-times" really appear to be irrelevent. Patients just stroll on in whenever they happen to get there--makes it impossible to stick to my plan of action. I have to take the patients off, strip the machines, bring them up again, and put the next 3 patients on. There are techs around to help, but we are so understaffed that I don't usually count on any help. Also, you don't get much help if you'
re out of the little cliques Also, we have lots of cath patients--the techs of course cannot set up the sterile fields--another thing that takes up quite a bit of time.
It makes be really mad when I'm in the middle of taking someone off, and the charge nurse yells out "Mr. so-and-so is here and waiting to get on! Often, (JUST AN EXAMPLe) he has a 1115 on-time but he has gotten there at 1045. Then the guy who really has an 1115 on-time gets there right on time and he ends up being taken late. It's like the patients run the show. I've complained about it, but management seems to be in total denial. Our patients are not called in. They just stroll on in whenever they want. I have spoken up many times saying that we need a system in which the nurse has the patient called in when the chair and machine and nurse and tech and everything else are ready for them. I'm told that '"that won't work in such a large clinic as this." WHY NOT? (There's also that old nursing thing that I hate about the patient always coming first. It has led to huge "compassion burnout" for me.)
Sorry about the rant. Love dialysis nursing, but I cannot clone myself and be in 3 places at the same time. Considering leaving nursing altogether--:uhoh21: no way will I go back to the hospital floor!
I'm an RN in a large clininc (50 chairs divided into 2 nursing stations). Usually get an assignment of 3 or 4 patients. The "on-times" are supposedly staggered, but it makes no difference--0the "on-times" really appear to be irrelevent. Patients just stroll on in whenever they happen to get there--makes it impossible to stick to my plan of action. I have to take the patients off, strip the machines, bring them up again, and put the next 3 patients on. There are techs around to help, but we are so understaffed that I don't usually count on any help. Also, you don't get much help if you'
re out of the little cliques Also, we have lots of cath patients--the techs of course cannot set up the sterile fields--another thing that takes up quite a bit of time.
It makes be really mad when I'm in the middle of taking someone off, and the charge nurse yells out "Mr. so-and-so is here and waiting to get on! Often, (JUST AN EXAMPLe) he has a 1115 on-time but he has gotten there at 1045. Then the guy who really has an 1115 on-time gets there right on time and he ends up being taken late. It's like the patients run the show. I've complained about it, but management seems to be in total denial. Our patients are not called in. They just stroll on in whenever they want. I have spoken up many times saying that we need a system in which the nurse has the patient called in when the chair and machine and nurse and tech and everything else are ready for them. I'm told that '"that won't work in such a large clinic as this." WHY NOT? (There's also that old nursing thing that I hate about the patient always coming first. It has led to huge "compassion burnout" for me.)
Sorry about the rant. Love dialysis nursing, but I cannot clone myself and be in 3 places at the same time. Considering leaving nursing altogether--:uhoh21: no way will I go back to the hospital floor!
Wow... that's really sad that your NM or Charge doesn't stick tothe appointment times. Ours DOES.
Sure, some of our patient may casually stroll in, hoping they might get on a bit early, and IF that just happens to work out, fine. But we NEVER put them just because they show up early. They have APPOINTMENT times, and we stick to that, and they know the score. They know they cannot slip in before the person who is supposed to go on before them. We have a waiting room and they wait until we call them back... when we are READY for them. Not a moment sooner. If they walk onto the floor before their time, we just let them know that we are not ready for them yet and that we'll come get them when we are.
CONSISTENCY is key here. Most of our patients are real good about it, as they know what to expect by now.
Of course, we are a small clinic, 12 chairs, 2 shifts on M-W-F, and one shift on Tue-Thu-Sat.
We, too have usually 4 pts. apiece, and do most of our setting up and tearing down of machines but our NM does help out as much as she can during turnover, as well as whoever is scheduled for "water/bicarb person" for the day.
Our techs (we only have one right now) do caths just like we do, so he is totally responsible for his patients.. we listen to breath sounds for him , and give the meds for his pts., but that's it.
It's all in your management... your charge or NM should be consistent in the having the patients follow their "on times". Our pts. see how busy we are and understand that we cannot be in three places at the same time, and are very sweet and understanding.
Sorry that this has become a bad experience for you.
Small clinincs, however, run SO much more smoothly, IMO.
Yikes. I'm glad our center doesn't have any cliques. We all get along and work our tails off...Techs and Nurses. We have different levels of techs...a Tech I is a tech that has been trained, but still hasn't taken the exam (has a temporary certificate)....a Tech II is a tech that has passed the BONET exam...and a Tech III is one who has gotten training to handle caths.
I can't believe a tech is in charge of scheduling! Here, we have a schedule that is made up by the RN Shift Manager. Then we have a Charge Nurse that will make sure everything runs smoothly throughout the day. Ssometimes they swap around patients from the different sections schedules in order to make the turnovers better. We do take in patients early sometimes if the seats vacent or what have you, but for the most part, it's pretty close to how the schedule looks.
We had one pt today though that was here an hour before his scheduled appointment time & when I put him on, he complained about being put on late. Another tech and I quickly explained that no, he wasn't late...he got there too early. Well, he still didn't like that so we told him to talk to the shift manager on Tuesday (his next tx) to ask for an earlier slot if possible.
So, are you saying that dialysis working conditions are better than working Med/surg in a hospital?
I'm an RN in a large clininc (50 chairs divided into 2 nursing stations). Usually get an assignment of 3 or 4 patients. The "on-times" are supposedly staggered, but it makes no difference--0the "on-times" really appear to be irrelevent. Patients just stroll on in whenever they happen to get there--makes it impossible to stick to my plan of action. I have to take the patients off, strip the machines, bring them up again, and put the next 3 patients on. There are techs around to help, but we are so understaffed that I don't usually count on any help. Also, you don't get much help if you'
re out of the little cliques Also, we have lots of cath patients--the techs of course cannot set up the sterile fields--another thing that takes up quite a bit of time.
It makes be really mad when I'm in the middle of taking someone off, and the charge nurse yells out "Mr. so-and-so is here and waiting to get on! Often, (JUST AN EXAMPLe) he has a 1115 on-time but he has gotten there at 1045. Then the guy who really has an 1115 on-time gets there right on time and he ends up being taken late. It's like the patients run the show. I've complained about it, but management seems to be in total denial. Our patients are not called in. They just stroll on in whenever they want. I have spoken up many times saying that we need a system in which the nurse has the patient called in when the chair and machine and nurse and tech and everything else are ready for them. I'm told that '"that won't work in such a large clinic as this." WHY NOT? (There's also that old nursing thing that I hate about the patient always coming first. It has led to huge "compassion burnout" for me.)
Sorry about the rant. Love dialysis nursing, but I cannot clone myself and be in 3 places at the same time. Considering leaving nursing altogether--:uhoh21: no way will I go back to the hospital floor!
All units do things differently. Our unit is a MWF unit, with 12 chairs, we do have 3 shifts, and we all try to be there by 5a, and generally leave by 6p. We have NO reuse or water person, (techs are cross-trained and take turns doing that AND being on the floor) and we have no secretary/Admin Assist. to help with ordering, phones, filing, paperwork, inventory, reports, etc. It is just us. 2 RN's, 3 techs. OH, and did I mention, 2 of the techs only work part time because they are going to nursing school (great for them, bad for us), which leaves, 3 people to do all of it. During school holidays and summer, we all feel like we are on a vacation after working that short staffed! Oh, and we don't have a doctor except 1 time per month. Our med. director comes eomonth, and the other MD comes 1x month. So actually 6 months of the year it is once per month, the other alternating six we have 2 different MD's, once during the month. SUCKS, but what can you do?
:o
jnette, ASN, EMT-I
4,388 Posts
Again, that depends on your particular unit.. they vary, but you can figure on it being quite early. Our first patients go on at 0500, meaning that we are htere by 0415-0430 to get the machines ready and tested, bicarb and acid out, etc.... Running two shifts, we are usually done then and leaving by approx. three pm.. if all goes well.
Some clinics start a bit later. like 0600... but that's the latest I know of any starting.. still means you'd need to be there a good half hour earlier.
You might want to go back and chat with them and get all the details... or give them a call and make notes.
Wish you the best. :balloons: